From the Framingham Heart Study, National Heart, Lung, and Blood
Institute, Framingham, Mass (P.W.F.W., D.L.); Boston University Mathematics
Department, Boston, Mass (R.B.D., A.M.B., H.S.); and Framingham Heart Study,
Boston University School of Medicine, Framingham, Mass (W.B.K.).
Background—The objective of this
study was to examine the association of Joint National Committee
(JNC-V) blood pressure and National Cholesterol Education
Program (NCEP) cholesterol categories with coronary
heart disease (CHD) risk, to incorporate them into coronary
prediction algorithms, and to compare the discrimination properties of
this approach with other noncategorical prediction functions.
Methods and Results—This work was designed as a prospective,
single-center study in the setting of a community-based cohort. The
patients were 2489 men and 2856 women 30 to 74 years old at baseline
with 12 years of follow-up. During the 12 years of follow-up, a total
of 383 men and 227 women developed CHD, which was significantly
associated with categories of blood pressure, total
cholesterol, LDL cholesterol, and HDL
cholesterol (all P<.001). Sex-specific
prediction equations were formulated to predict CHD risk according to
age, diabetes, smoking, JNC-V blood pressure categories, and NCEP total
cholesterol and LDL cholesterol categories. The
accuracy of this categorical approach was found to be comparable to CHD
prediction when the continuous variables themselves were used.
After adjustment for other factors,
Conclusions—Recommended guidelines of blood pressure, total
cholesterol, and LDL cholesterol effectively
predict CHD risk in a middle-aged white population sample. A simple
coronary disease prediction algorithm was developed using
categorical variables, which allows physicians to predict
multivariate CHD risk in patients without overt CHD.
© 1998 American Heart Association, Inc.
Special Reports
Prediction of Coronary Heart Disease Using Risk Factor Categories
28% of CHD events in men and
29% in women were attributable to blood pressure levels that exceeded
high normal (
130/85). The corresponding multivariable-adjusted
attributable risk percent associated with elevated total
cholesterol (200 mg/dL) was 27% in men and 34% in
women.
Key Words: coronary disease • prediction • hypertension • cholesterol
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